Our goal in collecting this information is to enable our officers and other first responders to be better prepared to assist your loved ones in an emergency. Accurate and timely information regarding individuals in our community who require special services will better ensure a safer and more effective emergency response. Examples of those who may require a more specialized response include, but are not limited to; Autism, Down Syndrome, Alzheimer’s, and Dementia.

Completion and submission of this form is voluntary. You can revoke your authorization at any time. We consider the information on this form to be confidential. This information will only be used for authorized law enforcement and emergency medical purposes.

We do request that you contact us annually regarding the data submitted on this form, to confirm that it remains valid, and provide us with an updated photograph. This will ensure that we have the most current and accurate information. If pertinent information needs to be updated throughout the year, please contact our administrative office during regular business hours.

Completed forms may be mailed or delivered to:

                                  Administrative office hours (excluding holidays)

Please do not hesitate to contact us if you should have any questions regarding this form.